My goal in seeking a Mentored Career Development Award is to acquire the additional training and experience necessary to for a career as a health services researcher evaluating the quality and appropriateness of medical care. As outlined in my application, I will focus on the treatment of coronary artery disease (CAD) as a model for examining the quality of decision making, since the appropriate treatment for stable CAD should include consideration of patient preferences. My long term goal is to make medical decision making more patient-centered by creating metrics to assess decision quality from the patient point of view. The major goal of this K08 application is to develop a conceptual framework and a first-generation instrument that can be used to assess the quality of decision making in patients with CAD. The instrument will eventually be used in an R01 proposal for a randomized controlled trial to determine whether a patient decision aid can improve decision quality and/or affect utilization of cardiac procedures among hospitals in California. The research and training outlined will take place primarily at the University of California, San Francisco (UCSF), within the Philip R. Lee Institute for Health Policy Studies and the Department of Medicine. Both have strong research environments and extensive resources that afford virtually unlimited opportunities for interdisciplinary research and education. I will also work with the Foundation for Informed Medical Decision Making, a non-profit organization that promotes the understanding and adoption of informed medical decision making. The directors, medical editors, and advisors to the organization encompass world-renowned researchers in shared decision making. I have assembled a mentorship team that includes Dr. R. Adams Dudley, Dr. Rita Redberg, and Dr. Steven Gregorich, who have expertise in quality measurement, cardiology, and biostatistics, respectively. I will also seek the counsel of Dr. Anna Napol?s and Dr. Albert Mulley for their expertise in qualitative research and shared decision making. I will work closely with my mentorship team and consultants, who will provide support and guidance throughout all phases of the award. In addition to taking advantage of the resources of my institution and my mentors, I will expand my knowledge base about qualitative research methods and decision making through attending formal courses at UCSF, the University of California at Berkeley, the University of Michigan, and the Dartmouth Summer Institute for Informed Patient Choice. I will also attend courses and meetings sponsored by the Society for Medical Decision Making, the primary society for the discipline of medical decision making in the United States.
Significance There is little prior research about how well patient preferences are being incorporated into medical decision making, particularly when the balance of harms and benefits is dependent on patient values. Assessment of the quality of the decision making process is vital to determining whether appropriate, patient-centered care is taking place.
|Lin, Grace A; Lucas, F Lee; Malenka, David J et al. (2013) Mortality in Medicare patients undergoing elective percutaneous coronary intervention with or without antecedent stress testing. Circ Cardiovasc Qual Outcomes 6:309-14|